Provider Demographics
NPI:1669832036
Name:KOTCH, MICHAEL (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KOTCH
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 VIRGINIA BEACH BLVD # 219
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4419
Mailing Address - Country:US
Mailing Address - Phone:757-585-3273
Mailing Address - Fax:
Practice Address - Street 1:3419 VIRGINIA BEACH BLVD # 219
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4419
Practice Address - Country:US
Practice Address - Phone:757-585-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00637400101YP2500X
VA0701010899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional